How EHR Optimization Can Improve Prediabetes Screening

There are an estimated 84 million people in the United States living with prediabetes (higher-than-normal blood sugar level). The National Diabetes Prevention Program (DPP) has proven effective at coaching people to make lifestyle changes. Yet making referrals to DPP a regular part of clinical workflow has proven challenging. The American Medical Association, the Henry Ford Health System and Epic Systems have worked together on EHR optimization to improve the referral process.

In a June 26 presentation in Thomas Jefferson University’s “PopTalk” series, Kate Kirley, M.D., director of chronic disease prevention in the Improving Health Outcomes group at the AMA, described the effort at Henry Ford. Kirley, who serves as the lead clinician on the AMA’s diabetes prevention initiatives, began by noting that the DPP lifestyle coaching program method developed by the Centers for Disease Control and Prevention (CDC has been shown to reduce the incidence of type 2 diabetes by 58 percent compared to placebo.

Prior to joining the AMA, Kirley was a practicing family physician and health services researcher at NorthShore University HealthSystem, and a clinical assistant professor in the Department of Family Medicine at the University of Chicago. She says most primary care doctors are not yet screening patients for prediabetes in ways that are consistent with guidelines and are missing people who should be screened. Research suggests that fewer than 23 percent have ever made referrals to DPP, she said. “The role of physicians is to identify at-risk patients, document it in the EHR and tell their patients, then engage them in shared decision making about their treatment options, and then support them,” she says.

The AMA is working with healthcare systems and physician practices on their diabetes prevention strategies, including improving systematic screening and referral to DPP and also looking at where technology can support prevention, including EHR optimization and digital and mobile health solutions, she said

Kirley described a year-long effort working in partnership with Henry Ford Health System, a Michigan-based integrated health system, to optimize their instance of Epic to support clinical processes. This included adding some clinical decision support features, solutions to support patient engagement and bidirectional e-referrals to DPP.